Molly Journal #4

Every day is a slightly different patient load and is made up with patients I have never met before and also patients with conditions I have never seen before. Friday we had a slightly lighter load of patients, which was a little unusual. Maybe it was because it was a Friday or maybe it had something to do with the march many kids had that morning before school, considering a baby girl with a high fever came in later in the day because her older sister had the march to go to. Her older sister was dressed in a purple, satin-like princess dress.

I know for my host family preparation for the march started out the day before. My host mom had a pretty white satin-like ribbon out and was decorating it with silver glittered letters. She then proceeded to making white dresses for both of her young girls, one is three and doesn't even go to school yet but was included in the festivities. The older one slept in curlers that created small tight ringlets and the younger girl had nice natural curls and didn't need much but some ribbons added to her hair. The next morning, the day of the march, the girls woke up early, for their standards, around 6:30 a.m. They had to get ready, get something to eat and wake up before the start of the march, 7:30 a.m. The dresses were beautiful and had blue ribbons lining the bottom. And each girl was wearing glove-like pieces with a loop around the middle finger. They looked like princesses. My host mom carried the younger daughter so that she wouldn't get any orange clay on her dress and her brother brought the older daughter on a moped. When we got to where everyone was gathering, there were around one-hundred young children and some of their parents. Those who had cameras were taking pictures. From just a glance you could tell everyone and their mom put a lot of effort into their outfits. The youngest child in my host family is definitely not a morning person and I did not see one smile or hear one word from her all morning which is very rare. So in the pictures she doesn't look so happy. I left around 7:45 a.m., before the march started, and caught a collectivo to Coxen Hole just in time before the police closed the roads. I made into the hospital with perfect timing to start the day.

Every patient is different and even if they receive the same diagnosis, they are unique. Today however I met a young boy with a cephalic disorder. I recognized the name but could not recall the different severities of the disease or the typical prognosis. He could not stand or walk on his own and his mother carried him wherever he needed to go. Normally I use the measuring tape on the wall of the clinic to take a three year old's height and the stand-up scale, but for him I had to measure his height on the table and his weight on the scale for infants. His height actually exceeded the measuring tape, but it wasn't so much that I couldn't estimate the rest. He clearly was uncomfortable in general because he kept tearing up but could not voice his concerns like other children his age. While shadowing Dra. Cerritos I learned a little bit more about his condition and the fact that his mother has other children to take care of as well. What matters is that the little boy has the support of his family and Dra. Cerritos help to continue monitoring his condition.
 
This reminded me of my host family and how the older daughter has a disorder. She can speak so her family understands her and slowly I've been able to understand bits and pieces of what she says. She also has difficulty controlling her motor functions. She can walk, sit, stand, go up and down stairs, etc. but not with the same ease as any other child. Her facial muscles are also difficult for her to control. You can tell in a couple of the pictures her mom took of us with my phone that she cannot control her facial expressions from moment to moment and almost always she has saliva on the top of her shirt. Despite the differences Nicole is good-natured, thoughtful, well-behaved, and positive young girls I have ever met. Maybe it is because she is the oldest child and has taken it upon herself to be responsible. I know my host parents have done a fantastic job of loving and supporting their kids which makes all the difference in the world. Nicole attends school with other students her age and plays with her younger sister, cousins, and friends when she is not in school. I am so happy for her that she has this support system and is treated much like any other child.

Molly Journal #3

Today was the first of three days that Doctora Cerritos is teaching a course for pregnant women and women with newborns near the hospital. The relationship between patients and providers is very important and I think that it is fantastic that Dra. Cerritos is teaching the class for three days to educate women about their health and their child's. This can be considered a means of preventative medicine and one that I think is very important. Communication is key to many things in life and sometimes spending the time to explain something to someone or to talk to someone or even to ask a question can make life easier in the end. Keeping parents up to date on how to best care for their kids is important to health care professionals but I think it is just as important to the patients and their families. Families form a ring of support and if a mother has to work, many times her mother brings the child into the hospital, looking out for their family members. Without this support system, I do not even want to think what could happen to the child without getting the healthcare they need.
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Because of the classes Dra. Cerritos is teaching, the pediatric clinic is closed for the next three days. After talking with Alice on the phone I figured out that the clinic had not had a thorough cleaning for a very long time. It is important to make sure the clinic is as clean of an environment as possible. Of course I clean throughout every day, but dust has gathered on a lot of the shelving, doorways etc.
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So I started my day by taking the collectivo and going into Coxen Hole to go to Eldon's supermarket. I was hoping they were open at seven or eight at the latest so I could get an early start. I got lucky. Apparently the store's hours on the week days are 7 a.m.- 8 p.m. I found what I needed right away and paid $10 for eight rolls of paper towels to stock up the clinic. I use paper towels to clean the exam beds, tables, chairs, baby scale, etc. along with Lysol and occasionally some fantastik.
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I walked along the busy roads in Coxen Hole down my normal route but in addition to my backpack, this time I had a huge package of paper towels. I got to the hospital, opened the clinic and turned on the air conditioning because I was hotter than normal, carrying those paper towels,  wearing my backpack, and wearing long pants all the way to the hospital. Good thing I started early in the morning.
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I started dusting shelves, crevices, desks, and removed most of the stuff to make sure I got everything. It was disgusting how much dust I picked up, folding the paper towel every which way to make sure I didn't waste any of it. When I got tired of dusting I started going through medications we have (not that many) and got rid of those that  were expired and reorganized the ones we could keep according to the labels already on the shelves.
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Halfway in between that job I needed a change and continued dusting. I started tackling the windows,  and the frame behind the curtain that was coated with dust. The dust was so thick on them it makes sick to think about all of the other rooms in the hospital which are just as bad or worse. Next I started dusting on top of doorways and their frame and the tops of shelves where they probably have not cleaned since the shelves were built...
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I made a lot of progress on the cleaning and organizing. The pediatric clinic is one segment of the hospital. We have our own main door which I can lock and opens into a small hallway lined with benches on each side, and also people. Normally at 7:30 in the morning and until noonish it is difficult to walk down the hallway. Our pediatric clinic has three rooms, a main room (the biggest) with the main desk and computer, baby scale, normal scale, changing table, mat for measuring babies and a for children, a small file cabinet for forms and charts, and a couple book shelves for equipment and for books. This room is sufficient to support the services we provide and I'm glad the hospital has Global Healing's clinic for the community.
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When I was all done cleaning. All of the trash cans were completely filled and so I asked the cleaning ladies to come in and empty them for me. Thirty minutes later and after bothering them three times they came. They asked me about the clinic being closed today and why I was there. I told them the clinic needed cleaning and so I spent all day working on that. They must have been very surprised because that was the first time I had seen any of them smile at me. Usually I try and be very nice to them, but they don't seem very friendly, to me at least. After today I hope they understand that I respect them and think that they have important jobs and the hospital would not be able to function without their help.
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I thought about going to the class Dra. Cerritos was teaching for mothers because I thought it would be a good experience to see what the structure is for the classes, to learn some myself, and also to give me another opportunity to work on my Spanish. However, I had my doubts about whether or not it would be okay for me to go and by the time I seriously thought about going, it was too late to talk to the doctor. So for the next two days I translated for Clinica Esperanza until late afternoon.
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This week I ran into a few patients from the hospital in a collectivo, in Sandy Bay, and at Clinica Esperanza. I was reminded that I represent Global Healing wherever I go and I'm proud to say yes when someone asks me if I work in the hospital after recognizing me.

Molly Journal #2

26 August, 2012
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This past Sunday I went to church in West Bay. The service was great as usual. Although I don’t like the songs as much as the ones back home. The band here isn’t as exciting, granted there are only three band members here and about nine back home.
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After church Ms. Peggy drove some of us to this park called gumba limba. This park is gorgeous. I actually wandered through here on my adventure walking to West Bay and didn’t know exactly what it was. Gumba limba is like a huge jungle/tropical rainforest. As you drive in under the canopied trees, you can hear the monkeys, birds and other animals that live there. Guest can zip line, walk through the canopy, see the many iguanas that roam around, kayak, dive, etc. Of course this is all for an extra fee and is for people who aren’t stuck using crutches to get around…
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Anyways, the real reason for coming to Gumba limba is because of Sundae by the Sea, Clinica Esperanza’s annual fundraiser was being held there under a large gazebo like area (thank goodness we had cover because it rained at the beginning). The gazebo was huge and I didn’t notice at first but if you looked up at the ceiling there were bats. They were just chilling upside down, doing their thing. I joked with JJ (one of the volunteers/translators at the clinic who is a U.S. citizen, is applying to UMiami and grew up in Roatán) that hopefully none of the guests get the honor of getting guano in their hair.
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The set-up took a while and of course I couldn’t help. All I did was sit on my butt, but they did put me in charge of checking people in, collecting and selling tickets, handling money, etc. I did this all day and the live auction finally started around 2 p.m. By then I was so hungry for lunch…either way the live auction was exciting for me because I had never been to one before. The guys announcing the items were hilarious and overall it was entertaining. Some very cool things/opportunities were auctioned off live and in the silent auction. Some people will get to take a submarine ride down 1000 ft, spend a day as the mayor of Roatán, go in a hovercraft (or something cool like that), stay in a sweet resort for a week, get mani/pedi/massage for cheap, do some awesome diving, eat at some great restaurants, rent some sailboats, etc. I was lucky I couldn’t get around to bid on all of these items. All or nothing/go big or go home and this time choose the latter. Clinica Esperanza was lucky because so many supporters gave items for the auction.
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A couple of the best restaurants on the island donated food for dinner and of course all of the food was set up near my check-in table, tempting me for at least four hours after church and before we finally ate around 3:30 p.m. At the event there were drinks and of course ice cream sundaes. You can’t have Sundae by the Sea without sundaes. I was holding out until I got some real food until around 3:15 p.m. I was dying and needed to eat something, so I gave in, got some ice cream and when I was almost done, they started serving dinner. I knew that was going to happen.
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Dinner was amazing. I was super stoked to have a salad. I told JJ, who was getting food for the crippled (me), that I wanted lots of salad and then he could pile whatever looked good on top. He brought back a great salad with avocado, chicken and veggie shish kabobs, a bit of a surprisingly good potato salad, and some tasty rice. He told me when he piled on the lettuce and then everything on top people looked at him weird. I apologized and said people look at me weird all the time and for the most part I’m used to it.
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We finally finished up closing the deals on items, collecting money and packing up everything we brought. The fundraiser was a success, but of course the clinic still is trying to raise more money. It costs $450 for each baby born their (including birth, prenatal care and vaccinations) but the clinic charges patients less than $5 to see a doctor, no money for medications, and a dollar or two to get blood work or other lab tests done. Like I mentioned in another post Ms. Peggy is in the planning stages of building a trauma center for Roatán. She has a donor who is giving $1 million in equipment but they need $250,000 to build the center and more to continue operating. It will take time but I have faith that Clinica Esperanza will reach their goals. They don’t turn any patient away and are a great asset to Roatán. The Global Healing Pediatric clinic in the public hospital is also essential and treats patients from all around Roatán. Without this clinic a large majority of the patients would not be seen and would not get the treatment or medications they need.
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27 August, 2012
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Monday I went to the hospital, had a typical there triaging patients, finishing with paperwork, etc. I found out that Tuesday, Wednesday, and Thursday this week most of the hospital is closed because doctors participate in a Tuberculosis course mandated by the Honduran Ministry of Health. The next three days I will be volunteering in Clinica Esperanza as a translator, which is great to do in the afternoons after the hospital but now I will have a bit more time to practice my translating skills.
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Today I was lucky to get a free taxi ride all the way to the hospital so I didn’t have to crutch half a mile or so. I didn’t argue. I was just relieved to not stumble in the door to the clinic drenched in sweat. Every morning I unlock the door, turn on the lights, turn on the AC, and wait for it to get cooler…crutches.
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28 August, 2012
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At the clinic today I had some interesting cases but enjoyed translating for the patients/doctors. A urologist is in town for the next week and he is pretty cool, but I don’t think his male patients felt very comfortable talking to me…so when JJ got to the clinic I continued to translate for Gavin, a PA resident, and stuck with talking to the pregnant but married 15 year old, a couple old ladies, a retired Canadian, and more but still engaging.
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I also got my cast off today. Ms. Peggy sawed some of it off, the urologist did some (for the first time) and I also got to saw some of my cast off. I had never done that before so it was pretty cool. My wound on the top of my foot which happened while playing beach volleyball (sand sloughed the skin off) was stuck to the cotton inside of the cast. That cut is the reason why I rolled my ankle in the first place.
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I put on my socks and sneakers to keep the sand out after I cleaned it off and because I put my sneakers on and was higher off the ground, it was easier to roll my ankle with a misstep…anyways Ms. Peggy properly bandaged it so the wound can continue healing. Next she put an air cast on me, which is kind of cool. I never knew what it was but I am surprised at how well it works. I’m glad I’m walking again because it makes everything so much easier and also my ankle was a bit stiff so finally moving it again feels good.
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Today is my mom’s birthday and she turned the big 5-0. I’m excited for her and was disappointed I couldn’t connect to the Internet in the clinic to talk to her. So, around three after I finished up at the clinic I went home to my host family, had lunch and then took a collectivo to the hospital so I could use the Internet and the phone to call my mom and dad and to send my mom her birthday poem I wrote her.
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Afterward, I stocked up on apples, bananas, lettuce and peanut butter since I could walk again and go out of my way to the grocery store. I also splurged on some blackberries and 90% chocolate, without my cast on I was feeling like a million bucks and thought I deserved something special. I started walking out of the parking lot to go catch a collectivo just as Dee drove in. Perfect timing, he went shopping while I at my refreshing blackberries and then he drove me back to Sandy Bay from Coxen Hole.
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Recently I have been sitting on my butt a lot watching TV because I haven’t been able to do much. So I’ve gotten to know the Kardashian family fairly well, Bones, Numb3rs, How I met your mother, and the recent election excitement…I have also done a lot of reading which is enjoyable. Needless to say tomorrow I’m excited to kayak and snorkel a bit in the afternoon. It just started pouring and I’m glad it’s raining hard at night so hopefully the roads can dry a bit before tomorrow. It gets pretty dangerous here with the windy/hilly roads combined with the not so great vehicles. Good thing I’m walking to the clinic in the morning and can keep an eye out for myself.

Molly Journal #1

I had my eyes peeled, not knowing what to expect. Israel and I walked single file along the road through Coxen Hole. We made it to the hospital finally. I stepped through the doorway and saw patients sitting on wooden benches lining the hallways. Israel showed me the ropes and for the most part I watched him triage the patients. I knew I could do exactly what he was doing but I was so nervous because I respected the patients so much and didn't know the best way to earn their respect.

Every day patients and their family come to the hospital early in the morning, around six or so. I don't get to the clinic until 7:30 a.m. and the doctor until  almost a couple hours later. We finish up with patients anywhere from 12-1 p.m. So patients could be waiting for up to six hours! The patience the families have makes me respect them. Many of the parents have to miss work to bring in their kids. They have many other things they have to do and many times are torn between waiting for care and leaving early without being seen by the doctor. At the clinic we try and do everything to make things work out for the patients.

I learned that I'm at the pediatric clinic to do a job that many people can do, but I don't want to just do what anyone else can do. I want to do more. I try to get there early and get started as soon as I can. Everyday I fill my backpack with donations of toothbrushes, toothpaste, latex gloves, breathing masks and emergence response kits I brought with me to Roatán. I brought a large suitcase of donations and still haven't unloaded it all. These donations serve more than just their normal function. The colorful toothbrushes come in handy when the younger kids start crying because I have to weigh them, measure their height, or take their temperature. The girls love the bright pink and yellow ones and the boys the red or blue ones. I love to see every once in a while, an excited kid who comes in the door and runs straight to the small table in the corner, opens the crayon box and starts to color. I usually let them be until I have to torches them by taking their temperature etc.

Some of the kids and newborns come to the clinic just for a routine checkup, but not all of them. It's hard for them to be happy and smiling when they are uncomfortable. When they come into the clinic I just can't wait for the kids to get out the door because I know they will get their medications soon, which means they will feel better even sooner. All of the kids that come in are precious and I love to see them healthy and smile.

The people in Roatán are all incredibly welcoming and kind. I thoroughly enjoy giving back to the community in any way I can.

Israel Journal #4

Week 4: El Porvenir Es Del Pueblo

Despite the tumultuous weather this week, I at least started the week off well. I went to Clinica Esperanza to get my ear checked out and fortunately all that was wrong with it was from otitis media. The amoxicillin I have been taking is making improvements and I no longer have a runny nose. At the time I was getting my ear checked, Dr. Janice took advantage of the opportunity to teach my fellow volunteers what the inside of a normal ear is supposed to look like. My left ear was red on the inside and a little convoluted whereas it is normally a white color. During my time here in Roatan, my perspective has always been of the observer and to get a chance of being the one observed was enjoyable despite the circumstances because it provided an educational experience for me and the other volunteers.

On Tuesday, Hurricane Ernesto passed by north of the island and we ended up getting a few tails. It’s been a while since I’ve been through a hurricane so I was a little anxious at first that I had to ride into Coxen Hole and not know whether the roads would be flooded afterward. I also expected a short day at the hospital but oddly, it was actually much busier than normal. The pre-clinica area was a lot less crowded but other than that everything else was business as usual. We received about 23 expedientes and unfortunately could not start attending them early enough because the attendings had to cover in the pediatric ward. By the time they arrived, the people outside were getting quite impatient. It’s quite understandable however because the people here face a lot of pressure having to take time off of work to go to the clinica and on top of that, they will likely be spending money on medications afterward—not to mention that on this day there was a hurricane outside. One can see that in an area that has low resources like Roatan, there is a severe need for medical providers even when the people would risk getting a consult in a hurricane. Sometimes I wish I could fast forward already to my residency so that I can start helping people myself, but really I have an important task as well to reinforce what the attendings do. When you speak to people coming in for a consult in a respectful tone and show that you are there for them through your body language, they really receive this in a positive manner. This makes an otherwise distressful encounter that less stressful and encourages the patient to follow through on their half of the work including adherence and arranging follow-up care.

But sometimes even then there are the few occasional cases of neglect. One patient was brought in this week because a bone mass has been growing from his mandible. The patient’s mother said that the child was under the care of his father for the past year and a half and he did not want to bring him to get checked. The attendings were sure from the size of the bone mass that it was probably more than a year and a half that the mass has been growing. Fortunately, despite being late to bring the child in, there was a surgical brigade from Massachusetts in the hospital and the next day he would be taken in to get a biopsy. So despite the late timing, the child was able to get some help to begin his treatment process.

Another case that I heard about this week was of a baby with a respiratory illness in the pediatric ward. All that could be done to get the child breathing was tried and unfortunately the baby passed away. Kristen talked to me later about the case and she said that had this case been in the United States, the baby would have survived. I salute the physicians who choose to work here in Roatan so much because they are fighters. They come in knowing that they will likely not have many of the resources they need to provide for their patients. Yet despite this, they choose not to give up the good fight for their patients and they work hard at the issues they confront. This is the type of physician that I will certainly strive to be and I am so delighted that I can find this image in the physicians that I come in contact with everyday here at the hospital. For example, Kristen has learned in what cases a urine test or blood sample would provide the most benefit. She would like to order these for all patients, but sometimes the patients don’t come back to get the results and then again the process for getting something like a urine sample doesn’t provide a culture test as well so the efficacy of finding an unbiased result is questionable.

On Friday this week, Kristen, Lenia and I all made a trip down to the daycare to dispense albendazol and multivitamins, do teeth varnishes and to get height and weight measurements of the kids. Aside from my trip to Policarpo to see how the real Roatanians live, this was my most exciting experience outside of the clinic. We arrived at the daycare when the children were in their nap time. We had all just eaten a big lunch so even we were beginning to get a little drowsy ourselves. One by one the kids woke up and they moved straight across from us where they kept the pillows to lay down. As the lights were turned on, they woke up just a little more and we began our work. I took heights and weights as Kristen and Lenia attended the more serious cases. Before we began, we were hoping to put on some hand sanitizer but then noticed that there was none in the daycare. Kristen said according to the CDC, there should be copious amounts of hand sanitizer in any clinic so it has become a priority of mine to get them a sizeable container of it. The most severe case was of a little girl who had pain while urinating. Las profas mentioned that her urine would come out brown. Kristen said that the brown in her urine could possibly be from blood and so she wrote the little girl an appointment slip so she can come into the clinic next week. Right from the outset of our mission at the daycare, I was exposed to the beauty of the entire event and of all that Global Healing stands for: to provide help for those who do not have it readily disposable and whose needs are not being met. If we would not have been to the daycare that Friday, I can only imagine how long it would have taken for the little girl to get necessary aid and for the rest of the little kids to get their heights and weights checked. The other beauty of being able to provide for the daycare lies in who the help is being given to. The children of Roatan will be there to take up the reigns of this island once they are old enough and the trajectory that the island will take is ultimately up to them. While I can only guess from my own childhood that the stresses of their parents trickle down to them occasionally, because of the limited resources on the island that isn’t too wild of an assumption. What a better way to ensure that the legacy of this island is not in jeopardy than by providing the children a glimpse of altruism and love for fellow man by doing free consults at the daycare. 

Israel Journal #3

As I reach the mid-point in my internship, I already feel a sense of belonging but also that sense of departure. But the memories that remain of my time here in Roatan will nourish me until my next trips into Latin America. This week was certainly not my best as I got very sick for the first time. I started out with a sore throat and quickly my ear became infected. Towards the end of the week the infection moved into my other ear and now I feel very fatigued. Ultimately, however, I feel oddly proud of this sickness because it is almost like a testament of what I am willing to subject myself so that I can better understand a people and their healthcare system. I haven’t been able to get some meds for my infection because the hospital has been fairly busy this past week. We have been getting about 23 patients each day and we usually finish up by the time Clinica Esperanza has closed. Hopefully on Monday I can go and not to mention before the tropical storm hits. The part I do hate about this sickness is that I was not able to even go to the daycare this entire week to start my health workshop initiative because I didn’t want to pass on what I have to the kids. I was able to get them the nebulizer mask they needed at the very least though.

One of the things that I find great about the hospital is that there is no strict guideline that says you are only allowed to see x amount of people and anymore would be a violation. It isn’t uncommon to have a patient ask if their other child who they bring that day to also get a consultation. A particularly sad case that we encountered this week was a little girl who had a fungal skin infection throughout her body. The child was brought in by her aunt because her mother was adamantly against bringing her in to get checked out. I can’t help but think that the little girl’s household situation is the source of her sickness. I saluted her for having the courage to intervene and actively take responsibility for the well-being of another family member, even though it is truly the responsibility of someone else. When the aunt came in, she was originally coming in for a consultation for her daughter but asked if we could see her niece as well. Kristen agreed and she was sent on her way for a prescription. Juxtapose this image of a mother’s potentially severe negligence, with another mother who came in with her newborn. She brought in her baby because she had a high fever. She said that she knew her baby had a fever because she detected it with her thermometer. I don’t even have a thermometer at home.

Continuing, one thing I admire about physicians is their tenacity especially when dealing with a patient who does not seem to be improving despite taking their medications. A little girl this came in for the 4^th time since I’ve been here. Apparently her coughing hasn’t been getting better, but I admire Kristen for not feeling defeated that the previous medication regimen did not function as hoped and that she must be limited in her actions given the low resource environment that we find ourselves in. Lately I’ve been reading a copy of “How Doctors Think” and I read that this happens a lot in medicine. Plenty of cases get passed along to different specialists and sometimes it seems like there is some sort of mental issue at hand with the patient. But the physician should work toward thinking differently about the preceding diagnoses so that a better solution may be reached.

Israel Journal #2

Week 2: Y Ya Siento Flotar Mi Gran Raíz Libre Y Desnuda

The island has a particular quality that makes it easy for me to be contemplative, and the events from this week have provided me with much fuel for contemplation. Aside from the typical cases of otitis media or respiratory viruses, last week a baby was presented as having severe vomiting. At the time it was suspected that the baby possibly has pyloric stenosis, which is when a muscle under the stomach is enlarged and causes vomiting. The only cure for this is to get surgery and apparently the mother was quite distraught at this news and she opted to wait for another week before making any decisions. This week she brought the baby in and there was much of the same, so Jess referred her to a surgeon. I can’t even begin to imagine the stress the mother must be under. To hear that your baby needs surgery is not a light matter and one thing that I was wondering about was if the mother was more worried about the cost for this procedure. The thing about surgery is that sometimes, especially when it is life-saving, it tends to make people put a value on their health, which I believe is invaluable. If say a sick person did not have the necessary funds to pay for a procedure, needless to say that would be a very troubling situation. But imagine in Roatan where according to the locals, the average daily salary is $15; the cost of a surgery would be very intimidating. That’s why if I ever become a surgeon, I would work my best to keep financials from dictating what surgeries I can and can’t do. I certainly would not be averse to doing a surgery for free, if possible, because no patient deserves to be turned away just because they couldn’t afford a procedure, or rather just because they couldn’t afford to stay healthy. As I always say, I would be a physician even if it meant my salary was a piece of bread and a glass of water for each day.

This week was bittersweet as the clinic saw a change in the attendings. Jess left on Thursday and it was sad to see her go because I was getting to know her better and she definitely seemed to enjoy her work with the children here in Roatan. She is an ambitious person (she had to be if she majored in biomedical engineering as an undergrad) and is thinking about going into pediatric oncology. At any rate, life can be like that sometimes where cherished moments are transient so we must strive to make the most out of every moment of the day. On Jess’s last day working at the clinic, she, Tami (from Clinica Esperanza), Kristen (another attending physician from Global Healing) and I went to visit a couple of Jess’s patients in Policarpo or “La Colonia” which sits right across from Sandy Bay. To get to Policarpo, you have to traverse several steep dirt roads that veer off from the paved road. What I witnessed that day was very insightful to say the least and aside from my time at el hospital publico, it has been one of my favorite Roatan experiences so far. In the states, I am familiar with poverty (which I would now consider simply as “low-income”) but the conditions in Policarpo are of a different plane. One of the young girls’ families that we visited had a small makeshift kitchen outside of their house because it was built without windows. An upstairs section of their house was recently built and this section does have windows. The oven that they were using consisted of a slab of concrete with a shoe box-sized space carved in. Yet, even though the family lived in conditions which would be considered dire in the US, the family was happy as could be. The little children would just shower you with their love that you came to visit. They were not too shy to give me a hug although they didn’t know me. This type of happiness is something I am actually quite familiar with. From my upbringing, it is my understanding that when you suffer hardships with others, whether they are family or not, but you still maintain your optimism and you celebrate the fact that you still have each other, a special bond forms. This type of bonding is what I saw here between the young children and their mother. The message this special relationship proclaims is that despite our lack of necessities, we still have love and with that we can move mountains. As we said our goodbyes to this family, we headed further up the hill to see another patient who’s name is Michelle. Once we reached the top of the hill, there was an amazing view of a neighborhood that I had previously not known was so vast across the hills. Many tin roof homes littered the hillside, a definite change from the Spanish tile roofs I saw from the plane. When we found her, she was with her brother and another friend, Jenny, who is an adorable, playful kid. We then met Michelle’s mother and she told us about how she has been helped a lot by Ms. Valerie, who runs an HIV clinic on the island. Michelle’s house was recently built and there are a few renovations being made. At the top of the hill, they have a sizable tank of water to go along with their plumbing. Their bathroom is physically outside the house, and to go to the bathroom they have to walk a narrow path around the house. Also recent is an electricity post that was put near the entrance of the house. Aside from these commodities, the kids are going to a private school on the island run by Americans. The type of outreach that just captivated me was the medical care that was being offered to Michelle’s family. Michelle had a younger sister who had a congenital heart defect and her health was deteriorating rapidly after she was born. She was in the hospital for 3 months until she was set to go to the States for a heart transplant. Unfortunately, Michelle’s sister died before she got a chance to go to the US to get a surgery. Despite this tragic event, seeing and hearing about the great things happening to this family made me extremely happy that other people would be so giving to a population essentially on the periphery of global society. There are many wonderful people like that here on Roatan, including Miss Peggy, and being around them makes me very excited because it is this exact altruism that I would like to evoke in the future as a physician. After playing around with the kids, we headed to Clinica Esperanza for the rest of the day. Reflecting on this experience, I am quite unsettled by the fact that before now I had taken so much of what I had for granted. At the time I was uncomfortable knowing that the mentality I had in the US was to work for income so that I may obtain whatever silly material possession I desired. Now my mentality is to share my wealth with my extended international families so that they may have equal footing on par with my own.

Since Jess is gone, Kristen, a physician from Washington DC who has been working with Global Healing for a while now, will be taking over her clinical duties. I was able to shadow Kristen this week and she has exceptionally great bedside manners. Children that I triaged who were quite a handful would be calm during their consultations with Kristen because she handles herself very well. The interaction that she has with parents is also great because even though some get grumpy by the wait they have to endure in the humid waiting area, they leave their consultations happy and satisfied. I cannot wait for the other cases I will be able to shadow Kristen for.

After my time at el hospital publico, I have been going to Clinica Esperanza and to tutoring at Casa Mazapan, but on Friday this week, I went to a local daycare, Roatan Daycare, to get to know the children to start my health workshop initiative. Even though the kids were quite a handful, I had a lot of fun getting to know them and the daycare workers or “las profas”. The children in the daycare vary in age from 2 to 7 and the parents have started to pay in order to keep the daycare running. Previously, the daycare was free to single mothers who had to work during the daytime and had no one to look after their children. On Friday there was a total of 29 kids staying at the daycare, which consists of a play room kitchen, a general playing mat, a nap room, a kitchen and another play area along with a shower room. When I arrived it was nap time for the children and I had the opportunity to speak with la profa about Roatan and Honduras including the food, the lifestyles, the Roatan public school system, my experiences and about Roatan politics. One of the first children to wake up was an adorable little man with some pretty big cheeks, reminiscent of my own cheeks at that age. His name is Eldon and he has a respiratory complication which requires his meds of suero and salbutamol to be administered via nebulizer. Fortunately, his medication has been effective so far and he is no longer kept awake at night by his constant severe coughing. Unfortunately however, he could probably be improving at a much faster rate if not for the fact that the daycare is in need of a nebulizer mask. Several other children in the daycare also require use of the nebulizer and apparently during the raining season in October-November, there is a greater need for the nebulizer. Rather than being projected directly to their noses via a mask, the hose administering the meds have to be held in front of the children’s faces, leaving a majority of the medicine vapors escaping to the atmosphere. From where I was three feet away, I was able to inhale some of Eldon’s medicine. I spoke to Miss Peggy about this and fortunately she was able to secure a mask for the daycare and I will be taking it to them on Monday for general use. That is it for now, blog, and I will return with further thoughts.

Adios.

Israel

Israel Journal #1

Week 1: Entendamonos

Empiezo este discurso en espanol en honor de la cultura Latina que me va rodear por el proximo mes que anteriormente solo conoci de Mexico. Aunque no soy de familia Hondurena, todavía puedo disfrutarla y llamar este pais mi hogar. Inlcuso, este discurso es en honor de toda la gente que voy a conocer, ayudar y, si Dios quiere, toda la gente que ayudara en el futuro como medico. Ya cuando leen esta nota, jamas sera la misma persona. Pero no necesariamente es algo malo. Al contrario, yo me considere un humano un poco mas completo.

I arrived in Roatan on Saturday morning, July 14th in a state best described as a hodgepodge of different feelings. I was excited to start on an experience that I hope will continue to blossom as I forge my own path in life and also a little nervous because I want to give my best to the people of Roatan Global Healing. I’ve never been on any island before but as the plane ascended onto the tarmac, you could already tell that the island was picturesque to say the least. Deep blue ocean wrapped around the lush greenery on the island littered with buildings topped with Spanish roof tile. Dee, who I will be staying with for my trip, greeted me and took me on a short tour of Coxen Hole and Sandy Bay. In Coxen Hole there was a greater density of cement homes, some without windows, some homes along our way looked like they were half finished. Some homes were made entirely of wood and a few were in pretty poor shape. We traversed a few dirt roads until we reached the main highway which is a two-way paved road. Before arriving here, I was not sure what the island would look like. I’ve read that Honduras is considered a “developing country”, but even then I wasn’t sure what image to associate that term with. After the little tour throughout Coxen Hole and Sandy Bay, I realized that to a significant degree the population is poor. Although I am not a stranger to being low-income in the US, this was poverty at a different level. I have always held this belief that your character is not determined by the amount of money that you make, and after my first week at the clinic I have already determined that this is not just true in the US but even internationally.

I was anxious to meet Jena, who is the HEAL intern at el Hospital Publico de Roatan, and curious enough I met her while snorkeling right after I came from the airport. This alone tells me just how relaxed it is to live on the island. Curiously, I don’t even keep track of time. As for snorkeling, with a little push from Dee I got used to snorkeling even though I was really apprehensive about going out so far from land. The reef itself was very vibrant with its curious formations and the vibrant sea life. At the end of it I was happy that I wasn’t afraid to step out of my comfort zone. I have a feeling that I will be doing plenty of that during this internship.

Monday was my first day at the clinic and everything went extremely well. Jena met with me in front of Miss Peggy’s home and we hailed a taxi to el Hospital Publico. Right before we arrived at el hospital, Jena made a comment that it would not look like how I would imagine and oddly she was right. El hospital publico is a modest, largely single floor building with a lot of different clinics inside and a large ward which comprises the Emergency department. I imagined that the hospital would have a general waiting area and a little more organization. There were a lot of people sitting on benches and standing in front of the registration office. Rather than having waiting areas, the hospital has benches where the patients can sit as they wait to be attended. Jena and I made our way to the Global Healing clinic (Clinic #10) and the work began. That is where I also met the two attending physicians: Jess, who is a resident at Stanford, and Lenia, who is completing what is the equivalent to residency in Honduras. Jena is an excellent teacher and she gave a lot of terrific advice which helped me adjust to my duties. One of my duties as an intern is to triage patients for the Global Healing clinic at el hospital. Jena first demonstrated all of the questions to ask the patient’s parent(s) and where to place their records for the attendings. For the first couple of patients I fumbled a bit but as I kept working I felt as if I was getting better. And according to Jess, I got much more efficient at triaging by the end of this week. One observation I have made about the types of sickness that the children here have is that there are generally more cases of communicable diseases whereas a resource-rich country like the US has a significant number of children with chronic illnesses.

After my time at el hospital which has been ending generally around noon, I also have been going to Clinica Esperanza and volunteering there. For the most part, it looks like the clinic is fairly full with volunteers so I would like to include another activity in my afternoons. I am hoping that I might be able to do health education at the library or maybe plan a study comparing the health beliefs of children with diabetic parents and children with non-diabetic parents. I have started tutoring a few school kids at a nearby after-school program and that has also been very fun. 

Jena Journal #2

It’s hard to believe that today is my last day at the clinic and in Roatan. Where did the 5 weeks go? Yesterday I introduced Israel to the clinic and he has already settled in nicely. He’s very meticulous in his work, a quality I’m sure will serve him well as a doctor. With him here, I’ve been able to spend a lot more of the past two days shadowing the doctors, which has been fun and informative. A few of the patients these past few days have been repeats, and I love it when they recognize me and that I get to see the follow up. Most of the kids look so much better!

 As I’ve shadowed the doctors, I have noticed that they always make sure to go over basic health practices with each patient, beyond the specific complaint (things like “wash your hands” or “try and keep their wound clean”). I didn’t see the necessity of such common sense advice until last week, when I learned the importance first-hand. I spent most of Thursday and Friday in bed with an upset stomach and a diagnosis of parasites and dehydration. Apparently I needed one of those basic reminders: “make sure to drink a lot of water”.

 There have been lots of newborns in the clinic these past few days, so I’ve had the opportunity to see a lot of illnesses common to that age. The most striking was the little baby who had swollen nipples and a “baby period”- I never would have thought mothers could pass their hormones on their babies. There were also a few rashes and a couple babies with a yellow tint in their skin. However, there were very few cases where the doctors prescribed more than vitamins, as most conditions just disappeared with time. Sometimes the body’s ability to autocorrect amazes me.

 It’s fun to think back over the past week, and over my whole time here. I have really enjoyed my stay in Roatan and at Global Healing. I’ve seen a new side of medicine, met lots of great people and practiced my Spanish (and, of course, enjoyed the beaches of this little island immensely). I am excited to go home, but it is hard to leave - this isn’t the first time in my life I’ve wished I could teleport. 

Goodbye Roatan (at least for now), Jena

Jena Journal #1

It is crazy to me to think that I have been in Roatan for almost 4 weeks now, and even crazier to think that in a little over a week I’ll be back home. How the time has flown! There are many things that I am looking forward to in the States, chief among them being air conditioning and no sand fleas, but I also wish I could stay on this little island paradise for a bit longer. It is a great balance between work and play: I generally spend my mornings in the Roatan hospital, my afternoons in Miss Peggy’s clinic, and my evenings exploring the island with other volunteers. Overall, I’d say it’s a pretty great life.

 The hospital has certainly been an eye-opening place to work: without running water or air conditioning, it isn’t what I’m used to seeing in the States. The contrast was driven home for me last week when a premature baby under the RVPC doctors died because the hospital didn’t have access to the ventilator he needed and his family didn’t have money to take him to the mainland. It was frustrating and confusing to see something so preventable take a life, and made me appreciate even more the efforts of organizations like Global Healing and Miss Peggy’s clinic.

 On a lighter note, the hospital has also taught me a lot about what I like and dislike about medicine. I know now that I could never study dermatology (I feel like I use half a gallon of hand sanitizer every time a child comes in with a rash), and that I love the feeling of fixing a problem and seeing immediate results (which mostly manifests when I give a feverish patient acetaminophen, but still, it’s something). I’ve also been able to expand my Spanish vocabulary. I learned the word for “breastfeeding” early on, as not knowing made for some awkward charades, and I’ve used the word for “kidneys” and “gall bladder” more than once. I’ll have to try to slip those into a regular conversation someday…

 The hospital has also given me a good idea of what life as a pediatrician looks like, at least here in Honduras. I get to triage all of the patients that come through the clinic, and then shadow the doctoras after, so I see a lot of the diagnoses and the treatments that are given. The most common ailments seem to be ear infections, fever, and rashes (bug bites and fungal infections being especially common). It is also interesting to see the different styles of all the doctoras. During my time here, I’ve had the chance to work with four: one a native Honduran, two volunteers from the US, and one resident in her last year at Stanford. All four have been fantastic, and quite different. I noticed one focused a lot on basic health recommendations, while another paid most attention to the specific problem. Bedside manners also varied: some focused more on the child, while other mostly addressed the parents. Yet, somehow, all of the methods and manners worked. I’ve seen that there isn’t one perfect way to approach a patient, but rather a way that works for each doctor. It’s a good lesson to learn.

 The afternoons in Miss Peggy’s clinic are lots of fun. As an unofficial volunteer, I usually end up helping in pharmacy. The pharmacy orders tend to come in spurts, so in the down time the other volunteers and I do everything from quizzing each other on medicine names to deciding which Harry Potter houses we belong in. I am also always careful to keep an eye out for banana doughnut man, who will single-handedly be the reason I gain 300 lbs in my time here. Life is short, right? In the evenings, the other volunteers and I explore the island. While here, I’ve tried iguana (gross), choreographed and performed a dance to Backstreet Boys at karaoke night, eaten more baleadas than I can count, and have snorkeled a lot. I’m excited to see what the rest of my time at Roatan will bring, even with only a week left. Pretty soon I’ll be introducing the new intern, Israel, to the clinic and to the blog! Get excited. I know I am.

 Until then, Jena