Amanda Journal #4

go with the flow

A piece of advice that is often given to travelers is to learn to be very flexible. Often things don't happen on time. Or they don't happen at all. Or they happen in a round-about way that doesn't seem to make any sense and takes a lot more time and maybe doesn't produce the results or arrive at the destination you were looking for but you just have to go with the flow.

While living in Brazil, I learned that when people want things to be done at a specific time (for example, a business meeting), they request that it be done on "American time" (as in, like a person from the United States would do it). It was not uncommon for both students and professors to show up half an hour late (or more... or not at all) to classes. When someone says they'll be there soon, usually that means within the next hour or two, not the next five minutes. Sometimes the bus doesn't show up. Sometimes the metro is broken down. Sometimes there is a strike or a holiday so everything is closed for three days (or more).

It's good to learn to go with the flow, to be able to adapt and figure things out when things don't go exactly as planned.  The idea that "time is money" is pretty deeply ingrained in our culture, and don't get me wrong, I like to have my schedule just as much as any other gringo (you should see my day planner from college... yikes!), but traveling has definitely helped me learn that a schedule can't rule my day or my life.

But how does that translate to healthcare?

In both clinics that I am working in here on the island, appointments are not scheduled at a specific time. You can set up an appointment for a specific day, but you still have to make sure you arrive early enough that your "spot" isn't taken. Dra. Cerritos hands out little tiny signed slips of paper with a date written on it. Patients/parents come back on that day and turn in that little slip of paper to the receptionist, who then gives them an even smaller piece of a paper with a number written on it. That represents their place in line to see the doctor. The doctors only see a certain number of patients every day (Dra. Cerritos sees 15) so if you are not here early enough, you don't get to see the doctor. I have talked to parents who have come as early as 6 in the morning to ensure that they are seen by the doctor. I don't start triage until 8:30. Dra. Cerritos doesn't usually arrive in the clinic until around 10:30 (She works in maternity in the morning with the new mommas), and sometimes it is even later than that. So families are waiting in the heat for literally hours to see the doctor.

I can't tell you how many times a morning parents peek their head in the clinic to ask, will the doctor be seeing patients today? What time does the doctor show up? And I cringe because I have to answer, "Well... usually she's here around 10:30, but sometimes she gets here as early as 8:30 or 9..." More than once, emergencies have come up in the maternity ward and she has had to rush off. In these cases, I have to work up the courage to step out into the little waiting area and tell the parents who have been waiting for hours in the heat with their hot, sick, crying kiddos that the doctor will not be able to see you today. I am so sorry.

The inconsistencies are really tough, and this goes beyond the scheduling. One day, the electricity went out. I was reading babies' weights with a flashlight. And with the electricity, we lost our air conditioning (Global Healing has provided an air conditioner that we get to use inside the clinic). So instead of stepping into a refreshing clinic, families stepped into a hot, dark room with a sweaty volunteer (me) to measure their kiddos. Another day, a different lock had been used to lock the clinic, so I spent all morning looking for the key and started triage late. The first week I was here, we ran out of paper towels so I had to use gauze to wipe down the clinic at the end of the day (PS thank you ALL for those donations.....I have never been so excited for disinfecting wipes). One morning I spent half an hour chasing a tarantula out of the clinic. Yesterday, I showed up at the hospital to find out that the specialized doctors had gone on strike after not receiving their pay. All of Dra. Cerritos' patients were turned away by the receptionist, which shouldn't have happened -- She is part of the hospital staff, but her salary from the pediatric clinic is paid for by Global Healing.

I've said it before, but to my foreign eyes all of this can feel a bit chaotic. It is good to see some of these inconsistencies alleviated by Global Healing. Today, thanks to the consistent paycheck from them, we will be able to see 15 patients while the other pediatric doctors do not.  As far as all the other surprises, I guess I'll just keep going with the flow.

Amanda Journal #3

doctors on strike

For the last two weeks, doctors who work for the public sector have been on strike here in Honduras. More than 700 doctors from 27 public hospitals around the country are demanding pay they have not received since the earlier this year.  The strike was called by the Colegio Médico de Honduras, which is like the association for doctors. They are demanding that these doctors be paid back pay, paid for the time that they have been on strike, and receive an increase in pay. 

ElHeraldo.hn

Last week, the Honduran government declared this strike illegal, saying that the doctors' association did not follow the correct procedures to declare their frustration to the government. The president questioned the ethics of these doctors, saying that those who are suffering most from this strike are the Honduran people who are missing their appointments. The doctors, while agreeing that the Honduran people are absolutely taking a hit by the strike, responded by saying, "We doctors have to eat, too."

The strike is complicated; the in's and out's are a bit confusing due to lots of finger pointing and questions about who's to blame, if the government has money to pay, etc. etc. Everyone is clearly frustrated. What I think is important to emphasize is that this is not the first time this has happened here. Apparently, this happens all the time.

I work with a doctor who works at the public hospital in the mornings as an emergency room doc (the emergency services are still running, thank goodness) and at Clínica Esperanza in the afternoons. When I asked him about the strike he told me, "We have to go on strike. We have to go on strike any time we want to get paid." He hasn't been paid in over six months for his work at the hospital and that this happens all the time; they go for months without pay, they go on strike, they get paid (usually just their normal salary - no increase for their paycheck being late or anything like that). Some people have been without some or all of their pay for as long as a year. 

My response when he told me this:  WHAT!? How do they live??

He said a lot of doctors build up a ton of credit card debt because that's what they have to live on while they wait. He's lucky enough to have another job in a private clinic, so he can always have some income. Some doctors do the same, work in a public hospital as well as a private one, but some do not. 

ElHeraldo.hn

Early last week the government told the doctors' association that if and when this is resolved, there is no money to give them any increase in pay whatsoever, and that they will not be paid for the days they have been on strike. 

Oh, by the way, last Tuesday, the Honduran national soccer team tied Jamaica, qualifying them to go to the World Cup in Brazil next summer. It was a crazy night -- we went down into town to watch the celebration. The president of Honduras declared the following day a holiday for everyone who worked in the public sector to celebrate the victory.  Hmm... the president can afford to give a vacation day to all public employees, but is unable to pay doctors?  Forgive me if I am being naïve, but something doesn't quite add up.

As far as my work in the hospital, it has not been as affected. Two weeks ago  I showed up to the hospital and opened the clinic, only to find out that all our patients had been turned away under the assumption that the pediatrician that I work with was also on strike. Dra. Cerritos came in at her normal time, frustrated, because she was indeed planning on seeing patients all day -- her salary for her work in the hospital is paid for by Global Healing, the organization that brought me here to the island. Technically, she is "on strike" for her other work in the maternity ward, for which she has not been paid, but since babies aren't going to wait until the strike has ended, she, like the emergency room doctors, has continued with her work. Aside from that first day, and the holiday declared because of the soccer win, we have been able to see kiddos regularly thanks to the consistent pay that Dra. Cerritos receives from Global Healing.

Amanda Journal #2

At least once a day, if not two or three times a day, a parent asks specifically to see Dr. Cerritos. We currently have a doctor here, Dr. Mark, who is doing a rotation and has been here for three weeks. He also sees patients, allowing us to see twice as many a day, but some parents simple say no. They want to be seen by Dr. Cerritos.

I was curious, so I started asking parents why they wait, even if it means waiting an hour or two longer. One woman told me, "Dr. Cerritos know the entire history of my son. She has known him since he was born. When he was born, he and I were both very sick. I nearly died. She has been with us from the very beginning and she will always be my child's doctor".  Another mother told me she really believes Dr. Cerritos is a great doctor. She told me she has also been coming to this clinic since her daughter was born. She trusts Dr. Cerritos because she checks everything: "She doesn't just look at my daughter then write a prescription on a piece of paper. She looks all over her body. She makes sure her whole body is healthy."

These parents are just like all parents all over the world. They want the best for their kids and they know that a consistent pediatrician is important. Parents always ask me questions about their kids' weight, height, is it normal? We use CDC growth charts to keep track of height and weight for kids as they grow up, and they are a great tool to show parents how their child's growth compares to an average child and at what point they should be concerned, and I always tell them they should bring any concerns up with the doctor. 

Usually, we see moms or grandmothers bringing in their kids, but every once and while, I see dads, brothers, sisters, aunts and uncles.

We've had a couple very sick kids over the last week, and with them come some very scared, nervous parents and family. One little teeny tiny preemie baby was here, just a couple of weeks old and only 5 pounds. He had a cough and had a lot of difficulty breathing. Dr. Cerritos listened closely and carefully and spent a lot of time with this little baby. It broke my heart to see that little baby and his mother, who looked so sad and scared. She sat there with her baby in her hands and cried. Dr. Cerritos had the baby admitted to the pediatric in-patient unit in the hospital. Another kiddo came in with x-ray results showing a fractured skull. Upon hearing this from the doctor, the sister (who was the one who had brought the little boy) gasped and covered her mouth with shock. She held back her tears as Dr. Cerritos signed a pass for her to take the ferry to the mainland; she needed to go to the hospital in San Pedro Sula, today, as soon as possible, to see a neurosurgeon there, and it was important that they admit the child today. The fear (and sometimes guilt) that comes up for these family members is heartbreaking. They just want their child to be healthy.

Last week a sick baby was in here for a long time with Dr. Cerritos with a very high fever. She was admitted to the hospital. This week, her mom came into the clinic, carrying her baby girl with her. She was beaming. Her baby was doing much better and they had been able to go home. She wanted to come thank Dr. Cerritos for her care and to show off her happy, healthy baby girl.

It is so good to see parents who care about their kids. I'm hoping to find some materials for parents to read while they are waiting those 2-3 hours and make a reading shelf to put in the waiting area. It will (hopefully) include coloring and reading books for kids along with educational materials for parents. If anyone knows how to get a hold of books, magazines, pamphlets, or flyers in Spanish about family health, I'd be interested to hear! I know these parents want the best for their kids; they seek out good pediatricians and stick with them and ask good questions, and better informed parents will have healthier kiddos!

Amanda Journal #1

I’ve been in Roatán for a little over a week. It’s been exhausting (mostly due to information overload) but it has been really good.

one room

Last week, I got a good taste of what the next three months will be like: in the mornings I’ll be in the public hospital in Coxen Hole at a pediatric clinic with Dra. Cerritos, a Honduran pediatrician. There, the core part of my day is spent doing triage before Dr. Cerritos sees patients. I weigh babies and kiddos, measure heights and head circumferences, take temperatures, hand out stickers and tickle tummies. After the doctor (or doctors – right now we have a doctor here doing a rotation with the clinic, which is super helpful; we can see twice as many patients every day!) sees patients, I enter the data from the visits into a database that keeps track of who we see, where they’re from, and the doctor’s diagnosis and recommendations. 

this is where I weight & measure kiddos

the other room

waiting area

The hospital is so different than what I’m used to. It is unbelievably hot. People are everywhere. While doctors are seeing patients, other patients and nurses and doctors walk in and out of the room. It feels… chaotic. All of this, of course, is through the eyes of foreigner. Of course it feels different. But it does not feel unsafe. Doctors and nurses are caring for their patients, and caring for them very well, with the few resources they have. The hard part is that they have few resources.

Nursing Education

On Thursday and Friday, I sat in on a couple of classes that were given by three nurse educators who came down for Global Healing to look at how they might expand their outreach in the hospital. The classes were for nurses and covered care for diabetes patients, and care for low birth weight babies. One of the educators mentioned that she has seen nurses sit with a baby for an hour without leaving their side to monitor the baby’s health. A Honduran nurse spoke up, saying there is no way they would have to sit with one patient for an hour. Later, the question of hand washing came up – The hospital has few sinks with functioning water and I have yet to see a dispenser for antibacterial gel. The nurses recognize that they don’t always use the best hand washing techniques between every patient, sometimes they don’t make it to the sink, or there is no soap, or whatever. They fully understand the importance of washing their hands (they spend just as much time in nursing learning to wash their hands as we would in the USA—and any nursing student would tell you it’s the first thing you learn), but how can they wash their hands properly when they don’t have soap? Or antibacterial gel?

These are my initial observations. It is hard to see some of these things, and it’s important to see them. But equally (if not more) important is seeing that these professionals want to care for their patients in the best way possible, and they are trying to do so. As far as my role as a volunteer in all of this, I’m not sure what to think exactly, except that I am going to learn a lot. If anyone has any insight, I would love to hear it. All these things have been tumbling around my head all week. Luckily I’ve been able to chat about it with other volunteers, but I’d love to hear what friends and family back home think about this, or experiences they’ve had. 

So yes, it’s been exhausting. But I have been incredibly blessed to be living with an amazing, welcoming family who I have no doubt will take really good care of me while I’m here. They’ve showed me around the island, introduced me to their family, and have made me some amazing food (Doris’ baleadas are AMAZING!!). Sunday was Independence Day here, and this weekend was full of festivities, including several parades.

One week has already been eye opening… it’s going to be an interesting three months.

Heather Journal #2

This week I basically learned how to trouble shoot -- and I will say I didn't always do an awesome job. Unfortunately Dr. Cerritos' baby was ill and she wasn't able to make it to the hospital. Communication gaps made it difficult to know when she was here and if she were coming. It was disappointing telling the mothers who had waited with me that she was not in when I thought she was but hopefully she will be back next week. I sat in the clinic for a bit each day in case anyone had questions I could help with. I gave a few women my phone number so they could call before they came in to see if the doctor would be here and I put signs on the door each day. In the afternoons, I continued at Clinica Esperanza working in the pharmacy. I also checked out the Sandcastle Library, a really neat non-profit that is currently running an afterschool hands-on science education project called BrainSpace focused around experiment-based learning. Visit their website to learn more -- the whole thing is really cool and they have a bunch of computers as well. I think that's a great idea since I see kids responding well to technology here -- as with in other places. This weekend my goal is to put together a good brochure about toddler nutrition to distribute here. There is currently a nutritionist at Miss Peggys who is working on a community health project here so I have asked her for her help. Then I need someone to translate it/make sure my Spanish is okay. 

Heather Journal #1

I arrived on this beautiful island only one week ago and already it feels like home. It is a place full of startling contradictions; the natural beauty of the beaches and hills and the kindness and welcoming of its people are juxtaposed against the harsh realities of poverty. I came to the clinic last Monday and was immediately thrown into the 'Monday rush' as interns here have come to call it. Triaging the babies at first was difficult because my Spanish tends to fail me when I'm nervous. Eventually though, I got the hang of it. One preconception (however unfair) that was immediately dispelled was that of the laaissez-faire mother. Seeing all the kids running around barefoot outside at first made me conclude that unlike their overbearing, ultra-concerned American counterparts, the mothers here would take a more let-them-be approach with their children, the way my own grandfather ignored all cuts or scrapes unless one of his children had lost a finger. Instead I find that the mothers here are more engaged and involved with their children's upbringing. The cult of motherhood here is strong. For example, even to come to our clinic mothers come at 7, get triaged in order which means it's sometimes as late as 9, and then wait for the doctor who comes (or doesn't come) at around 11. When she does not come, the effect is chaos as mothers who need lab tests checked and forms signed are turned away. But these mothers assure me they will return to wait again tomorrow.

When the doctor sees patients, I love the way she asks kindly what they are feeding their children and the way she treats the kids, calling all the boys papi and all the mothers mamacita. It seems like a lot of mothers are very adamant that they are feeding their children well, but she corrects them in WHAT they are feeding the kids. For example, many babies which are new to eating are not ready for the meat their parents feed them. She also extensively praises mothers who breastfeed saying that there is nothing better for a baby. She prescribes an MVI to almost every patient and for really skinny 5-9 year olds (mainly girls) she also prescribes nutella. Many many children also get prescribed medication for anti-parasitic piperazine, even without actual lab results just because epidemiologically its likely to have caused their stomach/diarrhea problems. I think the clinic could really benefit from a good nutrition brochure. I am going to ask over at Esperanza what kind of brochures they offer and see if I can't give one here to mothers once the doctor approves it. In the afternoons, I've mainly been working over at La Clinica Esperanza doing pharmacy work. I am excited to see what more I can accomplish this next week. 

Alexandra Journal #3

This week I met a young lady, 16 years of age who came into the clinic to ask if her child could be seen today without an appointment because she forgot to make one last time she was seen. I talked to her a bit while she waited to ask the doctor, and I found out that she her sister was 15 and pregnant. I know that it is culturally acceptable to have children at a young age here, however I think I’m right to assume these pregnancies were not planned. The 16 year old told me the father was waiting outside the clinic. I asked if she was married to him, and she said she was too young to get married. I wonder if the school has a sex education program or if any community outreach programs target sex education.

I’ve encountered two babies that were quite different than other babies I’ve seen.  One who was fascinated by her shoes and could look at them for a long time and would also stare at the ceiling. Her demeanor was very sweet and calm. The doctor was concerned she could not hear or speak, but the mother assured her that she could hear, and she was too young to speak words. Another child was super hyperactive and could just not stop moving. I knew this child had a neurological development problem.  I wonder if most parents of the island are aware of autism or ADHD. I believe there is a center to help kids with Autism, but I am not sure, and will ask the doctor next week.

A one year old infant girl I met also had a very calm and sweet demeanor would not cry. Her mother had momentarily left to the room while I was laying the infant down to measure her height, when she began to tremble. I told her mom who came right over to comfort her. She told me instead of crying when she got scared, she trembled.

This week I’ve heard a lot about Dengue. Sometimes there is a woman who comes to the waiting area to educate the parents about Dengue. The doctor in the clinic was talking to another woman about people who have had symptoms similar to Dengue but are not testing positive. The first sign seems to be high fever. I want to ask the doctor more about the true cases she has seen of Dengue and if she suspects a new type of disease outbreak.

Alexandra Journal #2

According to Pamela Kanellis, program officer at Global Mental Health,

            “When one thinks about health challenges in developing countries, diseases like HIV/AIDS, malaria, tuberculosis, and other tropical diseases quickly come to mind, but few think of mental health. In fact, three-quarters of those afflicted with mental disorders live in developing countries. Mental disorders are a leading cause of disability globally and represent 14 per cent of the global burden of disease. Despite the enormous health burden, it remains one of the most neglected diseases”.

I’ve had a recent experience volunteering at Clinic Esperanza, where I came into contact with a woman who had a follow-up for various lab tests and was being given another lab test to see if she had helicobacter pylori. However, what stood out to me was that she was describing symptoms of depression, such as not being able to go on with her daily routine because she could not stay awake. The med student in the clinic printed out a self-assessment quiz for depression, but in English. The woman was more comfortable with the Spanish language, so I helped translate some of the self-assessment. She was supposed to select how frequently she felt certain items on the questionnaire within the last two weeks. The assessment reviewed things such as appetite, sleep, feeling like one has failed one’s family or have let down oneself, to feelings of self-inflicted injury or suicidal thoughts. I felt a bit uncomfortable because I wanted her to answer truthfully and I did not want her to think I was judging her responses. I helped her understand how to score the test to get a result. She had fallen in the range of mild depression, but borderline moderate depression. I am not sure how the med student and doctor reviewed the results, and what they considered was severe enough for medication. I do know that the clinic carries antidepressants and I would have predicted they gave her medication since her depressive symptoms interfered with her daily life. One thing I wonder is how stigmatized are mood disorders and mental health illnesses on the island. How often do people seek help for feeling depressed? Do they seek medication? Is cognitive therapy even an option? Another thing to consider is: are these self-assessments easy to understand and are they culturally competent within the context of the island population?

Alexandra Journal #1

Thus far,  I have really enjoyed interacting with the locals from Roatan. Albeit the limited resources in the Hospital and canceled consultations, the mothers of the sick children or even children that have an appointment for just a check up, are persistent in getting the care that they need. They arrive early in the morning around 7:30 and stay until they see the doctor which is around 11 or sometimes noon. I saw one patient at both the Coxen Hole Hospital and Peggy's clinic that brought her infant son for respiratory problems. I talked to her at Peggy's clinic and she said that the cough medicine given to her at the C.H. hospital was not working. She was waiting at Peggy's clinic since 7 am and I talked to her at around 1. 

Another obstacle the mothers face is that they might not be able to receive consultation at all for that day because the Doctor has an emergency or several births to attend to in the maternity ward. This past Friday after the cancellation of consultations was made, I took a woman with her newborn that had an urgent note to the emergency and another woman with lab results to find the doctor in the maternity ward because she felt the results could be alarming and her child's stomach was extended. I saw the doctor's genuine concern when she saw the results and told her to go to emergency.

In addition, concerns of the patients include cost of medication and lab tests. The doctor in the pediatric clinic is personable and tells the mother not to fail her, in regards to getting the medication that is needed for the child to get better. 

I had come into contact with an HIV positive woman who had lost or not completely formed fingers, who wondered into the pediatric clinic. She had asked for milk that is given to her for free at the hospital. Since I did not know anything about free milk, I gave her lempiras to buy the milk. In retrospect, I wish I could have found the area of the hospital that gives aid to HIV mothers. I did tell, Ingrid, the social worker in the hospital. 

One thing that I have found great joy in is translating for medical and PA  students and those that have come to Roatan to volunteer before their residency at Peggy's clinic. I like being able to help the doctors understand the main concerns of the patient and helping the patient understand their illness and treatment regime. In my last clinic visit, I helped comfort a woman who got results from a mammogram test that the results are most likely benign. The doctor's note, from the mainland, cited that the nodules were most probably benign, however, if clinically indicated a sonogram should be done to verify. However, the woman cannot afford a sonogram and the PA told her that if symptoms arise that she should come back, but not to worry too much.  I also helped consult a woman that feared she had malaria. She forwent the test for malaria and dengue and was given treatment. Another encounter I had at the clinic was a mother whose child could not be treated at Peggy's clinic and was told to go to the hospital. What was interesting in talking to her was that she had to go to her mother's home, because she explained she was not married, before going to admit her baby to the hospital; she had spent the whole day at the clinic. I urged her to go to the hospital right after talking to her mother. 

Finally, I found interesting the explanation of why the American doctor decided to specialize in pediatrics. He said, he found a great satisfaction in treating children since most of Adult's problems chronic conditions are from their actions, such as eating badly, not exercising and smoking for years. Children are helpless, most often what they have is not at fault of their own, and it is gratifying to be able to look forward to their progressive development.

Jenna Journal #3

This week has been my final week in Roatan and it is sad to think my time here is coming to a close. The week has been quite uneventful in terms of triage – many of the same families have revisited and I have noticed  many patients outside of the hospital in Coxen Hole. Almost always they stop and  tell me how they are doing and it is so lovely to feel a part of the care of each patient and to know they are aware of how interested I am in their wellbeing. It has been sad saying goodbye to many of the patients I have come to know better and many of the staff at the hospital who have offered kindness, translation help and medical information throughout my time. In the afternoons I have been working at the pharmacy at Clinica Esperanza. The work is very similar to what I do at home (where I worked in a pharmacy on weekends). When I am not making up prescriptions for patients I use the free time to bag medicines according to dose, refill shelves and to reorganise some of the medication. I have learnt a huge amount in the pharmacy – often, as the medicine initially prescribed is not available, the prescribing doctor will come in to find a similar drug and explain the logic behind each decision and the impact the particular medication will have on a patients’ life. It has been very informative and I have enjoyed it immensely. 

This week some of the other volunteers and I have spent some evenings out in West End which has been lovely. Another night some of the newly arrived doctors came over and we played board games, made Mexican food and had a nice catch up. We also spent an early evening out on the sea – Mr. Dee kindly lent us his kayaks and we kayaked out to Anthony’s Key to see the dolphins. They were absolutely beautiful and the breathtaking sunset completed the adventure. It was a lovely thing to do and something I definitely recommend! The kayak back was a bit harder against the current but not too problematic and was lovely to be around the water too. 

On my last day a trunk full of volunteers (including Miss Peggy and Mr Dee) went to Frenchies, a little island just out from French Harbour. It was actually paradise – beautiful white sands, water so clear it looked like it was from a bathtub, palm trees, sunshine – I would happily have stayed there forever! We had a lovely day snorkelling, swimming, relaxing in hammocks and sitting in the sand. It could honestly not have been a more perfect end to the trip.

As I write this now I am currently in transit – my journey home has been a traumatic 23 hours so far but only 6 more hours to go! I already miss Roatan – the people, the lifestyle, the clinic and the sunshine. I have learnt a great deal about healthcare, both good and bad. My Spanish has improved, I feel much more confident triaging, I have learnt about many conditions I have never seen in the UK and many new ways of treating things. I have also learnt that urgency in healthcare can make all the difference, that infection control really is very important, that many mothers cannot find the time to take their children for treatment but positive reinforcement significantly helps that. I have also met some truly inspirational people whilst here: Miss Peggy, who is changing the world one person at a time through her kindness, efficiency and unwavering motivation; E, a nurse at the hospital who is getting involved in community prenatal projects in La Colonia which they are aiming to implement soon and will hopefully bring improved health to mothers and babies alike. She has also brought her own children into the clinic and her care and concern for them has been incredibly touching; also J, another volunteer who was paralysed from the waist down at 21. She came to Roatan as one of her rotations and despite the inconvenience of being wheelchair bound, she has managed to get around the island, become fully immersed in volunteer life and I have so much admiration for how positively she approaches life despite all she has been through. I hope to come back one day – Global Healing and Clinica Esperanza give the people of this island a new hope for health and are helping to bring happiness and wellbeing to this wonderful population of people.

Jenna Journal #2

Last Sunday we went to church with Miss Peggy and Dee for Easter Sunday. The service was really different to at home – much less formal, but I enjoyed it nonetheless. We then went down to West Bay and spent the afternoon on the beach. I snorkelled for the first time which was really cool, and saw some beautiful fish. It’s a shame to think the coral is dying out and tourism has removed so much of the reef. It was lovely to relax in the sunshine and wander up and down the beach. We made it home mid-afternoon and Miss Peggy offered our house up for a potluck, so all of the volunteers for the Clinica Esperanza brought a dish (some excellent cooking!) and we all spent the evening together eating and chatting. It was a lovely way to meet many of the volunteers and also to get to know everybody a bit better. This week has been very different in term of work – the doctor I was with last week has gone home and it’s now Dra. Cerritos, who is the main doctor for the clinic. My week has taken on a different structure; she normally starts and finishes later so I don’t tend to get home until about half past three so less happens in my afternoons. I still tend to go into clinic just as early though to use the internet and speak to my family – internet at home has been gone for the past week. Life in the clinic is very different too. Doctors from around the hospital refer patients to Dra. Cerritos so normally she has many more patients to see which have more serious medical conditions. Triage is much the same and I am proud of how my Spanish and my ability to engage with patients is improving. The week has seen some exceptional patients too – we have had 2 children very ill in clinic and many presenting with intestinal worms, something I’ve never seen in the UK. There have also been cases of children who are positive for HIV and Hepatitis and it so strange to see them alongside healthly children and know the prognosis of their disease – it is a very sobering experience. I have also come to recognise many mothers and children who have returned to the clinic or who bring their children in for newborn examinations but I met the day following the birth. It is lovely to see this follow through in care and also very pleasant to be recognised and talked to by so many of the people in the hospital. It definitely makes the experience more rewarding. Another thing I have noticed which contrasts sharply with home is that records are permanently getting lost – I have started a new file for the same patient three times in the last week! Very little is computerised and files often have a way of disappearing, never to be found again (or at least not found until a new one has been made!)

In terms of free time here, I have spent a little time in West End in the evenings which has been really good. It’s crazy to think that is the most happening place on the island but it’s so quiet compared to London! I also have two new roommates both of whom are very nice (although 8 years older than me and both engaged!) so it’s good to have a bit more company especially in the evenings. Work for school is going slowly... somehow Biochemistry will never be that engaging!

Jenna Journal #1

Arriving in Roatan was a daunting experience-  I had come from the snow in England and after 3 flights (including an 8 hour stopover in England) I was shocked by the heat, the sunshine and the overwhelming sense of being in a place I had never been in before. I met Dee at the airport who was with 2 other interns for Clinica Esperanza, both from the U.S. They were all lovely and welcoming and it was really nice to meet people who were in a similar position to me. The two interns were both from Howard University in Washington D.C. and were both fourth year medical students. Because of the U.S. system being different from the U.K, I discovered I was much younger than all the student volunteers (the youngest except me is 28 and I’m 19). Dee drove us to a large grocery store and we stocked up on food for the week before driving to where I am staying. I am in the beach house next to Miss Peggy, which is beautiful, spacious and has an incredible view of the docks and the sea. After settling in and unpacking, I met the two doctors who were staying here too and they took me over to meet Miss Peggy. She is absolutely lovely, kind and accommodating, which was such a relief to think there was someone so welcoming around in case of any problems. It’s strange to think of all the amazing work she has done here and how grounded she seems despite all of that. One of the doctors drove us to West Bay Beach for the remainder of the afternoon and the other interns and I spent the afternoon relaxing on the beach and getting to know each other. We took a water taxi back to West End and a collectivo to Sandy Bay. I was feeling quite nervous about my week but thankfully Miss Peggy popped over to explain to me my routine and I went to bed exhausted, but a little more confident about the weeks to come.

The next morning I took my first trip to the hospital in Coxen Hole. When I arrived I was quite shocked by the conditions – the beds were all falling apart, it was incredibly warm, there was no form of infection control on wards and many of the patients seemed to be very uncomfortable. I met Dr. Rachel who would be in charge for the week. She is a volunteer doctor from Indiana and had been there for 6 weeks already and helped me through the first week wonderfully. Every day has the same routine – Dr. Rachel would take me on rounds of the babies born during the night. She taught me how to do a newborn exam and explained everything really well. It was so interesting meeting many of the mothers, some of whom were as young as me. I couldn’t imagine ever having a child at my age, let alone in the Roatan Hospital – it must have been incredibly daunting and not in the least bit terrifying. I think Dr. Rachel really helped though – she gave everyone advice for the first few weeks, ensured they were all booked in for follow up appointments either at the hospital or their local clinic and then ensured their babies were healthy. I’m hoping to be able to attend some of the Clinica Esperanza pre-natal classes to see what things are like here. After rounds we went to the Global Healing clinic. I began triage – I was quite nervous to begin with, particularly about Spanish (many of the volunteers laugh at how I speak English like I’m from England and Spanish like I’m from Spanish. It’s such a contrast here to everyone who is American/Latino) but soon found it was quite okay. I have to find out basic information to fill out their records, and take height, weight and head circumference in babies under  one year. I then ask the patients to wait to be seen by the doctor. It’s lovely meeting patients and parents alike, many of whom are exciting to talk about their lives to me and to find out where I am from and my experiences of Roatan thus far. It is also a great way of stressing the importance of follow up care – many parents are busy and have many children and often don’t turn up when asked to return to clinic. Working in triage gives me an opportunity to highlight the importance of regular check-ups and to return when advised to by the doctor. I have also enjoyed building relationships with the children in clinic – oftentimes I sit with them when they are colouring and they tell me what they are drawing. It’s noticeably much easier to ask them to stand on scales or to measure their height when they trust me a little more. Dr. Rachel lets me shadow her in clinic when I’ve finished triaging so it’s been good to improve Spanish and see some of the conditions that have come in. Most of them are similar to what you would see in general practice back home. 

As this week is Semana Santa, the clinic stopped running midweek. Instead I went in for rounds with Dr. Rachel anyway and brought in all the supplies donated by friends, family and colleagues in the U.K. There was a lot of childrens’ pain relief, syringes, thermometers, sterile dressing kits, undercast padding and vitamins. I cleaned the clinic whilst it was empty – I figured there wouldn’t be an opportunity like this for a while so scrubbed down all the surfaces and the shelves for supplies, dusted away in all the corners and crevices and neatened up all the shelving areas. It at least made me feel like I was doing something useful even though there were no patients. We also went to the local print shop and made copies of all the documents used in clinic to make sure there were enough for the next week. By the time I finish at the clinic and figure out my way home it’s normally afternoon and I’ve been coming back and studying straight away – I’m conscious of the exams I have a month after I get home so I’m often found at the dining table struggling with biochemistry. In the evenings it gets dark really early and often I’m in bed by around 9pm so I’m up and ready for work early. I take walks on the beach too, which is lovely to be outdoor s and make the most of the nice weather. One evening the other interns and I went into West End and wandered around, looked at the shops and got a very nice Thai dinner. We also went for lunch today and had baleadas, the local food here. They’re about $1 and are wraps with beans, eggs, rice and are very salty but very nice! Today we had planned to go and explore the island but it’s been raining (complete downpour all day) so we stayed in with tea and biscuits (I’m definitely converting everyone to my British ways) and all managed to get a bit of work done for medical school back home. I also managed to speak to my family which was really nice because I’ve been missing them this week. As much as I’m having a wonderful time it’s odd to think of everyone at home all together. The experience here is fantastic though – I’m remembering why I wanted to be a doctor in the first place here. Healthcare is so different to home – there doesn’t seem to be any sense of urgency or any real continuity of care, and being in hospital seems to be a very difficult experience for the patients. Records aren’t really computerised and there is minimal structure and organisation to paperwork. I’m looking forward to the new week though –I’m meeting the doctor who is here most of the time but not been here this week and I’m also seeing more of island life and doing some sightseeing. This is a lovely experience and I’m so grateful to have to opportunity to be here in Roatan and working with Global Healing.