Monday, July 29, 2013

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.

Tuesday, July 23, 2013

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?

Monday, July 15, 2013

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.