Tuesday, April 23, 2013

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.

Saturday, April 06, 2013

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!

Wednesday, April 03, 2013

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.